Effect of progressive resistance training on persistent pain after axillary dissection in breast cancer: a randomized controlled trial

  • Gunn AmmitzbøllEmail author
  • Kenneth Geving Andersen
  • Pernille Envold Bidstrup
  • Christoffer Johansen
  • Charlotte Lanng
  • Niels Kroman
  • Bo Zerahn
  • Ole Hyldegaard
  • Elisabeth Wreford Andersen
  • Susanne Oksbjerg Dalton
Clinical trial



Persistent pain is a known challenge among breast cancer survivors. In secondary analyses of a randomized controlled trial, we examined the effect of progressive resistance training on persistent pain in the post-operative year in women treated for breast cancer with axillary lymph node dissection.


We randomized 158 women after BC surgery with Axillary Lymph Node Dissection (ALND) (1:1) to usual care or a 1-year, supervised and self-administered, progressive resistance training intervention initiated 3 weeks after surgery. A questionnaire at baseline, 20 weeks and 12 months assessed the intensity and frequency of pain, neuropathic pain and influence of pain on aspects of daily life. We analysed the effect using linear mixed models and multinomial logistic regression models for repeated measures.


A high percentage of participants experienced baseline pain (85% and 83% in the control and intervention groups respectively) and by the 12 month assessment these numbers were more than halved. A high proportion of participants also experienced neuropathic pain (88% and 89% in control and intervention group respectively), a finding that was stable throughout the study period. The effect on intensity of pain indicators favoured the exercise group, although most estimates did not reach statistical significance, with differences being small.


For women who had BC surgery with ALND, our progressive resistance training intervention conferred no benefit over usual care in reducing pain. Importantly, it did not increase the risk of pain both in the short and long term rehabilitative phase.


Oncology Breast cancer Axillary lymph node dissection Pain Resistance training 


Author contributions

GA participated in designing and executing the experiment, and in writing the manuscript. KGA was involved in designing the measurement tools, planning the analyses and in the writing of the manuscript. PEB was involved in planning the analyses and in the writing of the manuscript. CJ, NK, BZ, OH and SOD participated in designing the experiment and in writing the manuscript. CL participated in planning and execution of the study and in writing the manuscript. EWA was involved in planning and performing the statistical analyses and in writing the manuscript.


This work was supported by The Danish Cancer Society, (Grant Number R96-A6604-14-S22) and Tryg Fonden (Grant Number ID 112305).

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the ethical committee in the ethical approval (H-15002714), and all procedures were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

All participants gave informed consent to participate before any study related activities were performed.

Supplementary material

10549_2019_5461_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 22 kb)
10549_2019_5461_MOESM2_ESM.docx (28 kb)
Supplementary material 2 (DOCX 28 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Gunn Ammitzbøll
    • 1
    • 2
    Email author
  • Kenneth Geving Andersen
    • 3
    • 4
  • Pernille Envold Bidstrup
    • 5
  • Christoffer Johansen
    • 1
    • 6
  • Charlotte Lanng
    • 7
  • Niels Kroman
    • 7
    • 8
  • Bo Zerahn
    • 9
  • Ole Hyldegaard
    • 10
    • 11
  • Elisabeth Wreford Andersen
    • 12
  • Susanne Oksbjerg Dalton
    • 1
    • 2
  1. 1.Survivorship and Inequality in CancerDanish Cancer Society Research CenterCopenhagenDenmark
  2. 2.Department of Clinical Oncology and Palliative CareZealand University HospitalNæstvedDenmark
  3. 3.Department of Anaesthesiology and Intensive CareZealand University HospitalKøgeDenmark
  4. 4.Section for Surgical PathophysiologyRigshospitaletCopenhagenDenmark
  5. 5.Psychosocial Aspects in CancerDanish Cancer Society Research CenterCopenhagenDenmark
  6. 6.CASTLE Late Effects Unit, Department of OncologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
  7. 7.Department of Breast SurgeryCopenhagen University Hospital Herlev/RigshospitaletCopenhagenDenmark
  8. 8.Danish Cancer SocietyCopenhagenDenmark
  9. 9.Department of Clinical Physiology and Nuclear MedicineCopenhagen University Hospital HerlevCopenhagenDenmark
  10. 10.Section for Hyperbaric Oxygen Treatment, Department for Anaesthetics and OperationsCopenhagen University Hospital RigshospitaletCopenhagenDenmark
  11. 11.Institute of Clinical Medicine, University of CopenhagenCopenhagenDenmark
  12. 12.Unit of Statistics and PharmacoepidemiologyDanish Cancer Society Research CenterCopenhagenDenmark

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